The 2010 MW 6.8 Yushu (Qinghai, China) earthquake: constraints provided by InSAR and body wave seismology

By combining observations from satellite radar, body wave seismology and optical imagery, we have determined the fault segmentation and sequence of ruptures for the 2010 Mw 6.8 Yushu (China) earthquake. We have mapped the fault trace using displacements from SAR image matching, interferometric phase and coherence, and 2.5 m SPOT-5 satellite images. Modeling the event as an elastic dislocation with three segments fitted to the fault trace suggests that the southeast and northwest segments are near vertical, with the central segment dipping 70° to the southwest; slip occurs mainly in the upper 10 km, with a maximum slip of 1.5 m at a depth of 4 km on the southeastern segment. The maximum slip in the top 1 km (i.e., near surface) is up to 1.2 m, and inferred locations of significant surface rupture are consistent with displacements from SAR image matching and field observations. The radar interferograms show rupture over a distance of almost 80 km, much larger than initial seismological and field estimates of the length of the fault. Part of this difference can be attributed to slip on the northwestern segment of the fault being due to an Mw 6.1 aftershock two hours after the main event. The remaining difference can be explained by a non-uniform slip distribution with much of the moment release occurring at depths of less than 10 km. The rupture on the central and southeastern segments of the fault in the main shock propagated at a speed of 2.5 km/s southeastward toward the town of Yushu located at the end of this segment, accounting for the considerable building damage. Strain accumulation since the last earthquake on the fault segment beyond Yushu is equivalent to an Mw 6.5 earthquake

A tale of two cities : Hull and York

The main factor sustaining any healthcare is the investment in the people that deliver care. Technology does not care for people, buildings do not care for people. People care for people. Inequities in workforce distribution contribute to inequities in access to healthcare. Such inequities matter to all of us, contributing to worsening health outcomes in mental health, obesity rates and overall life expectancy. We know that roughly 70% of NHS investment goes on workforce. How this gets spent matters. This chapter explores further: -Getting the workforce right. -Workforce capacity, capability and organisational resilience -The challenges and constraints at a time of workforce expansion. -Evidence from primary care. -How workforce inequality can affect different locations. -Solutions to workforce issues and how to apply the

Developing medical students’ broad clinical diagnostic reasoning through GP-facilitated teaching in hospital placements

Purpose: Graduating medical students need broad clinical diagnostic reasoning skills that integrate learning across clinical specialties to deal with undifferentiated patient problems. The opportunity to acquire these skills may be limited during clinical placements on increasingly specialized hospital wards. We developed an intervention of regular GP facilitated teaching in hospital placements to enable students to develop broad clinical diagnostic reasoning. The intervention was piloted, refined and delivered to a whole cohort of medical students at the start of their third year. This paper examines whether students perceived opportunities to improve their broad diagnostic clinical reasoning through our intervention. Methods: GP-facilitated teaching sessions were delivered weekly in hospital placements to small groups of 6–8 students for 90 mins over 6 weeks. Students practiced clinical reasoning with real patient cases that they encountered on their placements. Evaluation of learning outcomes was conducted through a student questionnaire using Likert scales with free-text boxes for additional explanation. Focus groups were conducted to gain a more in-depth understanding of student perspectives. Results: As high as 87% of students agreed that their broad clinical diagnostic reasoning ability had improved. Thematic analysis of the qualitative data revealed four factors supporting this improvement: practicing the hypothetico-deductive method, using real patient cases, composing student groups from different speciality placements and the breadth of the facilitators’ knowledge. Students additionally reported enhanced person-centredness in terms of understanding the patient’s perspective and journey. Students perceived that the added value of General Practitioners facilitators lay in their broad knowledge base and knowledge of patient needs in the community. Conclusion: Our results suggest that medical students can develop broad clinical diagnostic reasoning skills in hospital settings through regular GP-facilitated teaching. Our approach has the advantage of working within the established curricular format of hospital placements and being deliverable at scale to whole student cohorts

New teams in general practice

The NHS is seriously under-doctored, with general practice being one of the worst-affected specialties. GPs are a highly trusted and valued profession by patients. In addition, the ‘gatekeeping’ function and continuity of care they provide is critical to the efficiency of the services as a whole, keeps hospital admissions down, and produces better healthcare outcomes for communities and populations. Major efforts are being made to recruit new GPs and retain existing GPs, but there are serious implications for the future of primary care, and general practice in particular, as GPs struggle to cope with increased workloads. Increasing the number of GPs in the workforce is critical, and this work continues as a priority. However, a parallel stream of work has developed to consider ways in which tasks ‘traditionally’ undertaken by a GP might be diverted to new healthcare professionals within primary care teams, freeing up GPs to concentrate on the care and management of their more complex patients

Clinical Comparison of the Performance of Two Marketed Ophthalmic Viscoelastic Devices (OVDs): The Bacterially Derived Healon PRO OVD and Animal-Derived Healon OVD

This clinical investigation compared the clinical performance of two marketed ophthalmic viscoelastic devices (OVDs): the bacterially derived Healon PRO OVD (test) and the animal-derived Healon OVD (control) under normal use conditions during cataract removal and lens implantation. This prospective, multicenter, randomized, parallel, participant/evaluator masked, postmarket investigation enrolled 139 subjects (170 eyes), 116 (143 eyes) of which were treated (73 test; 70 control group). Both test and control OVDs were used, at a minimum, to inflate the anterior chamber and protect the endothelium prior to cataract extraction according to the standard procedure. The surgeon completed a postsurgery OVD clinical performance questionnaire, and intraocular pressure (IOP) was measured before surgery and at the 1 day postoperative visit with Goldmann applanation tonometry. Any IOP measurement of 30 mmHg or higher was considered a "spike"and recorded as a study-specific, serious adverse event. The bacterially derived Healon PRO OVD was found to be statistically noninferior to the overall clinical performance of the animal-derived Healon OVD control; thus, the primary hypothesis was satisfied. There were no statistically significant differences between OVD groups for any of the additional endpoints relating to IOP changes or to safety, thus satisfying additional hypotheses. The Healon PRO OVD showed statistically significant improvements in surgeon ratings for ease of injectability, transparency/visibility, and ease of IOL placement. The safety profile was also similar between OVD groups with regards to serious and/or device-related adverse events, as well as medical and lens findings. The results of this clinical investigation support the safety and effectiveness of the bacterially derived, currently marketed Healon PRO OVD and indicate that the intraocular surgical performance was similar between the two OVDs

GP-facilitated teaching in hospitals: The way forward? [Response to letter]

Thank you for an opportunity to respond to the comments made by Ms Veliah and Ms Sharma in their letter titled “GP-facilitated teaching in Hospitals: The way forward?” The authors of this letter have raised a few questions which we will address in turn

Association of surgical interval and survival among hospital and non-hospital based patients with melanoma in North Carolina

Surgical excision is important for melanoma treatment. Delays in surgical excision after diagnosis of melanoma have been linked to decreased survival in hospital-based cohorts. This study was aimed at quantifying the association between the timeliness of surgical excision and overall survival in patients diagnosed with melanoma in hospital- and non-hospital-based settings, using a retrospective cohort study of patients with stage 0–III melanoma and using data linked between the North Carolina Central Cancer Registry to Medicare, Medicaid, and private health insurance plan claims across the state. We identified 6,496 patients diagnosed between 2004 and 2012 with follow-up through 2017. We categorized the time from diagnostic biopsy to surgical excision as 90 days after melanoma diagnosis. Multivariable Cox regression was used to estimate differences in survival probabilities. Five-year overall survival was lower for those with time to surgery over 90 days (78.6%) compared with those with less than 6 weeks (86%). This difference appeared greater for patients with Stage 1 melanoma. This study was retrospective, included one state, and could not assess melanoma specific mortality. Surgical timeliness may have an effect on overall survival in patients with melanoma. Timely surgery should be encouraged